MSCT对自发性孤立性肠系膜上动脉夹层的诊断与评估  

Spontaneous solitary superior mesenteric artery dissection:multi-slice spiral CT findings in ninteen cases

作　　者：陈志明[1] 关键[2] 严超贵[2] 李子平[2] 

机构地区：[1]中山市中医院放射科,广东528400 [2]中山大学附属第一医院医学影像科,广州510080

出　　处：《放射学实践》2013年第8期853-856,共4页Radiologic Practice

摘　　要：目的:探讨MSCT多种成像技术对自发性孤立性肠系膜上动脉夹层(SISMAD)的诊断价值。方法:搜集19例SISMAD患者的病例资料,其中4例经DSA证实,15例由临床随访证实,所有病例均行MSCT检查及薄层重建、VR、MPR和CTA等后处理。DSA术前完成MSCT平扫及增强扫描,未行DSA者3～6个月内随访复查CT。按Yun分型进行MSCT诊断,探讨各型SISMAD的影像特征,并结合文献分析其临床特点。结果:本组19例SISMAD按Yun分型法进行MSCT诊断,Ⅰ型7例(真假腔均通畅,可见假腔的入口和出口);Ⅱ型12例(真腔通畅,假腔无血流),其中Ⅱa型4例(假腔无出口),Ⅱb型8例(假腔内血栓形成,伴真腔狭窄);Ⅲ型0例(夹层并肠系膜上动脉闭塞)。MSCT的薄层、MPR、CTA及探针分析清晰地显示了SISMAD的内膜破裂及夹层内血栓情况;同时显示大动脉粥样硬化11例,内脏动脉瘤2例,髂总动脉瘤样扩张3例。SISMAD临床上好发于中老年男性,以不明原因的突发性腹痛为起病特点;动脉硬化及高血压是SISMAD发病的危险因素。结论:MSCT可准确诊断SISMAD并对其分型、发现内脏动脉或大动脉的相关病变,对其稳定性的评估有助于指导临床治疗。Objective： To explore the value of multi-slice spiral CT （MSCT） together with imaging postprocessing technique in the diagnosis of spontaneous isolated superior mesenteric artery dissection （SISMAD）. Methods： Ninteen patients with clinically suspected SISMAD underwent MSCT. Muhiplanar and three-dimensional images were obtained by ima- ging postprocessing techniques of volume rendering technique （VRT）, multiplanar reconstruction （MPR）, curved planar reformation （CPR） and maximum intensity projection （MIP） on a workstation. Results： According to Yun＇s classification, there were 7 cases of type I ,4 of type Ⅱa,8 of type Ⅱ b and 0 of type Ⅲ. Intimal tears and lumen thrombosis in aortic dis- section were clearly shown on VRT, MPR,CPR and MIP. Other MSCT findings associated with SISMAD were abdominal aortic atheroselerosis （n= 11）, visceral artery aneurysm （n= 2） and common iliae artery aneurysms （n = 3）. Conclusion： MSCT allows the comprehensive evaluation of spontaneous isolated superior mesenteric artery dissection in terms of mor- phologic features and extent, making it the first-line imaging modality for the evaluation of spontaneous isolated superior mesenteric artery dissection.

关 键 词：体层摄影术 x线计算机 肠系膜上动脉 动脉夹层 孤立性病变 

分 类 号：R657.2[医药卫生—外科学]